How Transgender and Gender Non-conforming Clients are Left out of Discussions on Quality Care.

In general parlance, when we talk about gender equality and/or gender diversity, we are often talking about the representation of women on equal footing with men. What is sometimes left out of this discussion is the reality of individuals whose gender, as perceived by others, does not fit the neat and traditional definitions of male/female. The male/female dichotomy is, at its core, an artifice which leaves out the real lives of many. Whether a client is one who in their core is different from the sex checked off on their birth certificate (transgender), or is simply someone whose expression and identity do not conform to what most of society expects (gender non-conforming or GNC), these clients are often not part of the conversation.
When said lives are part of mainstream discussion, they are fodder for political gain, on the one hand, and discounted on the other. As illustration, let us take the often contested question of bathroom use. On the one hand, we have presidential candidates delegitimizing the reality of transgender people needing to use appropriate facilities, and then “doubling down” on those comments as “common sense” when challenged.1

On the other hand, when policy is proposed to allow transgender/GNC persons to use the restroom that best matches their core identity, public rhetoric takes an ugly turn and accuses individuals of “pretending to be the opposite sex” for the sake of a cheap thrill at minimum and to commit crime at worst. I am not discounting the fact that, for many, there is a legitimate fear and possibly a triggering response to the use of same sex restrooms.

What is frequently left out of the discussion is:

The challenges that transgender/GNC people face in regard to using the restroom2

The fact that in 40 years of LGBT (lesbian, gay, bisexual, transgender) inclusive non-discrimination policy there are zero incidences of someone committing such an act in a bathroom and using non-discrimination law as a defense3

The reality is much darker than the bathroom diversion. As the Office for Victims of Crime and others point out, “One in two transgender individuals are sexually abused or assaulted at some point in their lives…a majority of transgender individuals are living with the aftermath of trauma and fear of possible repeat victimization.”4

In a client-centered model of care that is culturally-aware, understanding some insights into this diverse and resilient community is vital. For the purposes of this conversation, let’s elucidate a few key elements.

TRANSGENDER ASSAULT IS ABOUT POWER, BUT IS ALSO MORE THAN THAT.

Like all assault, the motivations behind an incident are as diverse as the people who commit such acts. However, assault may also be the mask worn for a hate crime meant to terrorize not only the individual, but to send a message to an entire community already minimized by society at large. In addition, an assault may be a form of “corrective rape”. Too often, we as Americans point to examples from developing countries when talking about the atrocities of rape to “correct” one’s sexual orientation or gender identity. We do not look at ourselves and the real ways in which perpetrators use power to communicate conformity to an idealized version of “normalcy.”5

Finally, for intimate partner assault it is important to consider the size of this community and the ramifications of, not only naming the perpetrator, but in simply admitting to the assault itself. In small, socially stigmatized groups such an act carries serious daily social ramifications for the survivor who must continue to thrive in that community.

HEALTHCARE FACILITIES ARE PLACES OF PREVIOUS TRAUMA & ARE TRIGGERING.

For many transgender/GNC clients, healthcare settings are not only places where one may be “outed” as transgender but are places filled with trauma and triggering factors. Consider the following facts from Texas respondents to a national discrimination survey in 2010.6

85% report having to educate their doctors about transgender related medical care

20% report being refused medical care due to their transgender status

26% experiences mistreatment by a doctor or hospital staff

Transgender clients have seen abuse by healthcare providers and have had to jump over hurdles just to get adequate care. In addition to the sexual assault, addressing concerns unique to transgender/GNC individuals exacerbates the trauma of the assault. Those working with transgender clients need to be prepared to support them and help them work through the body shame of being “different from other men/women” while also dealing with the incident.

RESPECT AND CLIENT CENTERED CARE MEANS CHANGING HOW YOU TALK AND ACT – SPECIFICALLY FOR FRONT LINE STAFF.

Most of us come from a place of privilege where we deal with individuals we can identify as “he” or “she” and where such statements as “He is here for his 10:30 appointment” are commonplace. We don’t think about the scenario in which someone’s gender is ambiguous or new to frontline staff. We don’t prepare or train staff members to ask each and every client what gender they should be addressed by. Most of all, we forget the little things that mean so much to a transgender person such as getting records, gender pronouns, etc correct. We forget to practice, and have honest discussions in regard to transgender/GNC realities and how to handle them in the workflow of treating sexual assault. The time to address that gap is now. It is my hope that you will use some of the following resources to educate yourself and your staff to foster an environment conducive to the needs of ALL sexual assault survivors.

Transgender/Gender non-conforming clients are a highly marginalized community. TAASA resolves to count, value and incorporate the uniqueness of the transgender/gender non-conforming community to our work. It is essential to the movement to end sexual violence.